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ICU and You  ·  Superpuzzle Series  ·  Number 52

The adolescent

Twenty clues  ·  companion to Mind Map #35 and Aphorism #39

What these puzzles are for

The crossword is a pretext. Twenty clues is not a syllabus and nobody learns intensive care from a grid. What a puzzle does well is hold your attention on a word for a few seconds longer than a list would, and put a fact beside it while you are looking.

So the clues are deliberately mixed. Some are practice points you should already know and may not have thought about lately. Some are pieces of physiology. Some are history — a person, a case, a year — because knowing where a thing came from makes it stick. One or two are simply odd, and those are in here on purpose: curiosity is the thing that makes the rest of it go in.

Several clues teach rather than test: you will see the answer immediately and learn something getting there. That is the intention, not a failure of construction.

There is a printable version if you would rather do it on paper, and a challenge at the foot of the page.

Twenty clues on the adolescent. One is a vaccine, one is a blow to the chest that stops a healthy heart, one is a membrane that may not take the tube you brought, and one is a question best asked when the room is empty.

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On a phone, scroll the grid sideways. Arrow keys move; typing a letter moves you on; backspace steps back.

Printable version  →

Across

  • 1When indicated, do the test on teenage girls before a potential CT, anaesthetic or even a teratogenic drug — and ask the sensitive questions when the room is empty
  • 4______ cardiomyopathy: the murmur that gets louder when the athlete stands up
  • 9No return to play the same day, whatever the player, the parent or the coach says
  • 11Five stages, scored separately for pubic hair and for breast or genital development. Stage 1 is prepubertal, so it does not mean puberty has begun — and you do not undress an adolescent to score it unless the answer changes something
  • 13The single leading cause of death at fifteen to twenty-four in Australia
  • 14Infection with this has a second Australian peak at fifteen to twenty-four, and over 80% of cases are now serogroup B — which the current (2026) national adolescent dose does not cover
  • 16DKA protocols do not always ask you to measure this. Levels can be low in hyperosmolar DKA and lead to rhabdomyolysis and haemolytic anaemia
  • 17Trade name of the vaccine now given as a single dose in Year 7, and the reason Australia aims to be the first country to eliminate a cancer as a public health problem: under four cases per 100,000 women a year
  • 18The tall adolescent with the spontaneous pneumothorax whose aortic root should always be measured
  • 19It peaks in adolescence and the window is hours, which is a poor reason to let embarrassment delay the examination

Down

  • 2Around a third of food-allergic younger adolescents prescribed one say they never carry it when they are on their own
  • 3Common, benign and temporary in mid-puberty — but take a drug history, and examine the testes, because a tumour there can secrete the hormone that drives it
  • 5Do this before the glucose comes down, not while it is coming down
  • 6Insulin ________, or interrupted pump delivery, lies behind most ketoacidosis in established diabetes
  • 7Front-of-neck access in an adolescent uses this rather than a needle. The adult technique, but not the adult tube — at sixteen the membrane may not take one
  • 8Withdrawal from it looks like agitation, and not many will mention having inhaled this if the parents are present
  • 10______ cordis. Not a diseased heart — a blow to the chest landing in the few milliseconds of the cycle that will fibrillate a normal one
  • 11Femoral lines in DKA carry so high a risk of this that the guideline's first instruction is to avoid the line unless resuscitation demands it, and to pull it as soon as you can
  • 12On standing, in assembly, with a warning — reassuring. During exercise, without one — not
  • 15Glandular fever swells it, and it can rupture with no blow at all — which is why the question is not how they feel but when they go back on the field

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